Evaluation of the Effectiveness of a Quality Improvement Intervention

Evaluation of the Effectiveness of a Quality Improvement Intervention to Support Integration of Maternal, and Child and HIV Care in Primary Health Care Facilities in South Africa

This rigorous evaluation demonstrated that implementation of a time-limited quality improvement strategy effectively improved coverage of some components of an integrated maternal and child health service in a complex health environment, but we were unable to achieve the changes needed to provide a comprehensive package of care for mothers and children.

Study Overview

• Status: Completed
• Conditions: Maternal and Child Health
• Intervention / Treatment: Other: Quality improvement intervention to strengthen health service provision

Detailed Description

Background: Despite policies and guidelines recommending integration of health services in South Africa, provision of maternal and child health services remains fragmented. This study evaluated a rapid, scaleable, quality improvement intervention to improve integration of maternal and child health and HIV services at a primary health level, in KwaZulu-Natal, South Africa.

Methods: A three-month intervention comprised of six quality improvement mentoring visits, learning sessions with clinic staff to share learnings, and a self-administered checklist aimed to assist health workers monitor and implement an integrated package of health services for mothers and children. The study evaluated 27 clinics in four sub-districts using a stepped-wedge design. Each sub-district received the intervention sequentially in a randomly selected order. Five waves of data collection were conducted in all participating clinics between December 2016-February 2017. A multi-level, mixed effects logistic regression was used to account for random cluster fixed time and group effects using Stata V13.1.

• Study Type: Interventional
• Enrollment (Actual): 1438
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

Women who attended the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017.

Exclusion Criteria:

Women who did not attend the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Provision of comprehensive care including the following: Baby: Measure weight and length Plot on appropriate growth charts in Road to Health Card (RTHC) Discuss with mother about the growth of the baby Identification of malnutrition and appropriate management Age-appropriate nutrition counselling Immunisation Developmental screening Vitamin A supplementation Deworming HIV Care: If mother is HIV positive -; Polymerase chain reaction (PCR) test for the baby repeated at 10 weeks; Nevirapine for the baby for six weeks Mother: Cervical cancer screening Provide family planning Screening tuberculosis (TB) and sexually transmitted infections (STIs) HIV Care: HIV positive mothers - provide ART for the mother and adherence support; HIV negative mothers- HIV test every three months while breastfeeding	Other: Quality improvement intervention to strengthen health service provision; Quality improvement intervention comprising of regular improvement meetings based at clinics.
Active Comparator: Control; Routine maternal and child care service delivery	Other: Quality improvement intervention to strengthen health service provision; Quality improvement intervention comprising of regular improvement meetings based at clinics.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Maternal and Child Care	Proportion of mother-baby pairs who received comprehensive care	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Child Care	Proportion of babies who receive growth monitoring services	3 months
Quality of Maternal Care	Proportion of mothers who receive feeding advice	3 months

Collaborators and Investigators

• Sponsor: University of KwaZulu
• Collaborators: UNICEF; Institute for Healthcare Improvement

Publications and helpful links

General Publications

• Haskins L, Chiliza J, Barker P, Connolly C, Phakathi S, Feeley A, Horwood C. Evaluation of the effectiveness of a quality improvement intervention to support integration of maternal, child and HIV care in primary health care facilities in South Africa. BMC Public Health. 2020 Mar 12;20(1):318. doi: 10.1186/s12889-020-8397-2.

Study record dates

Study Major Dates

• Study Start (Actual): January 18, 2016
• Primary Completion (Actual): February 5, 2017
• Study Completion (Actual): January 16, 2019

Study Registration Dates

• First Submitted: February 14, 2020
• First Submitted That Met QC Criteria: February 18, 2020
• First Posted (Actual): February 20, 2020

Study Record Updates

• Last Update Posted (Actual): February 20, 2020
• Last Update Submitted That Met QC Criteria: February 18, 2020
• Last Verified: February 1, 2020

More Information

Terms related to this study

• Keywords: Nutrition; Integrated care; South Africa; HIV/AIDS; Quality improvement; Child health; Maternal health; Growth Monitoring; Child Growth
• Other Study ID Numbers: UNIP123

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: IPD will not be shared
• IPD Sharing Time Frame: Anytime
• IPD Sharing Access Criteria: We are more than happy to share our study protocol, statistical analysis plan or informed consent with anyone who is interested.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No